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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS ORLEGAL: 3��v s����ti�.. �1n��4 <br /> PID: <br /> DESCRIPTION OF WORK: 17 �c�1� �- 2�tw�,p <br /> ------------------ ----------- ------ <br /> ZONNi G REVIEW BY: CQ,�.� DATE APPROVED: �o • �t -t�� <br /> BUII..DING REVIEW BY: DATE APPROVED: �n-� -n � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAi�T REVIEW � Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATER CONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECT'ION <br /> Number of SAC�Units OTHER (specify) <br /> ZONIl�i G CH�CK LIST Zoning District: Q-y <br /> Fire Department: �v�u.�N✓� Post Office: w��z.arN3 School District: t,;,,�sTo�v�c�4 <br /> Lot Area: Sq.ft. 2�,�Z1 .�3 Acres . �� Width /�1/�•3`� Depth Zv c�, y � <br /> Survey Submitted: Yes_ c� No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): j5� f Right Side: (,v� '� <br /> Reaz(Sueet): 70' t Left Side: 2�' 'F- <br /> Adjacent Structures: /1�7v�r�ftt�� Wetland: N 1/� <br /> Building Height: Def. Hgt. N/� Peal:Hgt. N�� <br /> Lot Coverage: �j, )� <br /> Grading: Staff Approval Date: it//� By: Council Approval Date: <br /> Septic: Staff Approval Date: N //�' By: <br /> Zoning File: # N//� Resolution: # Resolution Date: <br /> Shoreland District: y�C S <br /> Avg. Setback: N'/rr Bluff Setback: /✓/9- Lot Coverage: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' p � �L. <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No p�� Date of Council Approval: <br /> REMARKS(in house): G,k -4-c� ww��- o�T -tU /�►����c.�-r d!o. <br /> 7 <br />